Provider Demographics
NPI:1043469091
Name:PINKUS, LARRY DAVID (RPT,AP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DAVID
Last Name:PINKUS
Suffix:
Gender:M
Credentials:RPT,AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3335
Mailing Address - Country:US
Mailing Address - Phone:321-209-9219
Mailing Address - Fax:321-282-9219
Practice Address - Street 1:360 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3335
Practice Address - Country:US
Practice Address - Phone:321-209-9219
Practice Address - Fax:321-282-9219
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist